Thousands Flee Indian City In Deadly Plague Outbreak

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As many as 200,000 people have fled the city of Surat in western India after an outbreak of pneumonic plague that medical experts described as one of the most serious reported in the world in recent decades, officials here said today.

Less than 48 hours after the first confirmed death from the disease, officials in the industrial city said that 24 people had died and 137 others were being treated in hospitals. But unofficial reports, including accounts from doctors working in Surat, said that at least 100 people had died, and that the toll was expected to rise as house-to-house searches turned up scores of new patients.

Residents of Surat, a city of 1.6 million in Gujarat state, reported scenes of confusion and panic reminiscent of the plague outbreaks that devastated India before the advent of effective antibiotic treatment and insecticides in the 1960's.

The bubonic form of plague, which leads to the swelling of lymph nodes, is spread by fleas. Pneumonic plague, a fatal pneumonia, can result from the spread of plague from the lymph nodes to the lungs or can be transmitted by droplets in the air.

Witnesses in Surat described huge crowds at the city's main railroad and bus stations and on roads leading out of the city. Judging from ticket sales, officials said as many as 200,000 people may have left over the last two days.

Police cordons were reported to have been thrown around slum areas in which many of the cases originated, in an effort to prevent people from leaving. Vans with loudspeakers were said to be touring other areas of the city appealing to residents not to join the exodus.

P. V. Trivedi, the district collector, or top civil servant in Surat, said in a telephone interview that the city had been put "on a war footing." Officials were using every means, from rushing antibiotics and insecticides to the city to public appeals for calm, to stop the disease from spreading. "We're appealing to people not to leave because they could spread the infection wherever they go," Mr. Trivedi said.

After the first deaths became known on Thursday, officials in Surat used emergency powers to close all public gathering places, including schools, hospitals, restaurants and parks. Most factories and businesses were also closed, and most residents who remained in the city were said to be staying indoors.

The few people moving on the streets were said to be covering their faces with cloths, handkerchiefs or medical masks to limit the risk of infection.

Prakash Mehta, an executive of one of the diamond exporting companies that are among the city's largest industries, described the city as "deserted and locked up."

Reached by telephone, he said he had returned to Surat in the morning after driving his family to the neighboring city of Navsari on Thursday night and had discovered that most of Surat's population appeared to have fled. "They're trying to go by whatever way they can," he said. "By train, by car, bus, truck, anything."

Mr. Mehta said that city officials appeared to be giving deliberately understated figures on the number of dead and that there were rumors in the city that as many as 300 people had died. He said he had stood outside the grounds of the main hospital and watched workers cremating seven bodies in the hospital grounds. "They're not releasing the bodies to relatives for fear of further contamination," he said.

A report by Reuters, with a correspondent in Surat, quoted a city doctor who was not identified as saying that doctors in Surat estimated that "more than 100 people have died."

The same report, quoting doctors at the city's main hospital, said that 80 of the 100 plague patients in isolation wards were in "semicritical condition." Another doctor, Parvez Sheikh, was quoted as saying, "Patients come walking in and within minutes, they collapse and die."

After an emergency meeting in Delhi attended by Prime Minister P. V. Narasimha Rao, Health Ministry officials said that they had sent millions of tablets of the antibiotic tetracycline and hundreds of tons of DDT and other insecticides to Surat and that that had stabilized the situation. Medical experts said prompt treatment with antibiotics was likely to save many of those in the early stages of the disease, while the insecticides would control the fleas that transfer the plague bacillus from rats.

"The situation in the affected areas is well under control and there is no cause for alarm," said M. S. Dayal, the top civil servant in the Health Ministry.

But other accounts suggested that official statements might be intended mainly to prevent a wholesale evacuation of Surat, with the heightened risk this would pose of the disease spreading.

Surat, a textile, petrochemical and diamond-cutting center that has been one of the fastest-growing industrial cities in India in the past decade, is on the coast of the Arabian Sea. Gujarat and the adjacent state of Maharashtra have a combined population of more than 120 million people.

Official concern appeared to focus on Bombay, India's largest industrial center, which has an estimated population of 12.5 million. Newspapers in Bombay reported that trains running down a trunk line connecting Bombay to cities in the Indian interior had been ordered not to halt in Surat.

The reports said that Bombay health officials had ordered hospitals in the city to prepare special isolation wards and to arrange for the distribution of tetracycline tablets to passengers arriving by road and rail from the Surat region.

Medical officials said that there appeared to be two possible causes of the plague outbreak. One was that the disease had been carried to Surat by the large population of migrant workers from the Latur area of Maharashtra state, 250 miles east of Bombay, where an earthquake killed about 10,000 people a year ago.

In August, officials reported an outbreak of bubonic plague in 25 villages around the town of Mamla, on the fringes of the Latur earthquake zone.

Reports from Mamla have said that officials there believed the disease took hold when villagers fearing a new earthquake moved out of their houses but left stores of grain and other foods that attracted rats, leading to a rapid increase in the rat population.

Another theory was that the earthquake caused large numbers of forest-dwelling rats infected with the plague bacillus to migrate to nearby villages. Reports today said that a total of 81 villagers have been diagnosed as suffering from bubonic plague but that none had died.

An alternative theory offered by officials in Surat was that the outbreak there was caused by unusually heavy monsoon rains that caused widespread flooding in the poorest sections of the city along the Tapti River, worsening poor sanitary conditions caused by mounds of uncollected garbage. The floods were said to have drowned large numbers of cows and oxen, as well as dogs and cats. Many were left to putrify on mud flats after the floods receded, attracting rats.

A version of this article appears in print on , Section 1, Page 1 of the National edition with the headline: Thousands Flee Indian City In Deadly Plague Outbreak. Order Reprints | Today’s Paper | Subscribe